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1/58. Constrictive pericarditis following hemopericardium due to ascending aortic dissection: A case report.

    A 79-year-old woman, who had had no history of trauma, tuberculosis, or collagen diseases, was referred for examination of general fatigue and shortness of breath on exertion. physical examination revealed engorged neck veins, hepatomegaly, and ascites with abdominal distention. On chest x-ray the cardiac shadow was slightly enlarged and bilateral pleural effusion was present. An electrocardiogram showed low voltage of the QRS complex. Computed tomographic scans revealed two lumens in the remarkably dilated ascending aorta and the severely thickened pericardium. cardiac catheterization showed elevated right atrial pressure and elevated right and left ventricular end-diastolic pressures, in addition to a pressure record of early diastolic dip and end-systolic plateau in the right ventricle. aortography demonstrated aortic dissection localized to the ascending aorta. On the basis of these findings, the diagnosis of chronic ascending aortic dissection complicated with constrictive pericarditis was made. After subtotal pericardiectomy, graft replacement of the ascending aorta and proximal aortic arch was performed with successful results. Her postoperative recovery was uneventful. Histological studies of the pericardium showed fibrosis and marked infiltration of the inflammatory cells. No findings of specific pericarditis such as tuberculosis or collagen diseases were detected.
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keywords = effusion
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2/58. Carcinoid constrictive pericarditis.

    A 78 year old man presented with diarrhoea, anorexia, and progressive lower limb oedema. He was in atrial fibrillation and had a right pleural effusion and ascites. Ultrasound of the abdomen and 24 hour urinary hydroxyindoleacetic acid output indicated metastatic carcinoid syndrome. Cardiac catheterisation revealed pericardial constriction, and pericardial exploration showed a greatly thickened pericardium with no evidence of tumour invasion. The patient died within 24 hours of surgery. Necropsy findings were consistent with a diagnosis of constrictive pericarditis secondary to metastatic carcinoid syndrome.
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keywords = effusion
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3/58. Chronic constrictive pericarditis induced by long-term bromocriptine therapy: report of two cases.

    OBJECTIVE: To report two cases of chronic constrictive pericarditis that appear to be related to the intake of bromocriptine for Parkinson's disease. CASE SUMMARY: Two white men (aged 63 and 69 y) were treated with bromocriptine for four (40 mg/d) and two years (30 mg/d), respectively, with a cumulative dose intake of 58.4 and 21.9 g, respectively. The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction. echocardiography, computed tomography, and cardiac catheterization results were compatible with a diagnosis of constrictive pericarditis, so pericardectomy was performed on both patients. The anatomic pathology examination showed a fibrous pericardium; cultures were sterile. In the first case, pleural effusion recurred seven months after the pericarditis; bromocriptine was suspected and treatment was discontinued. In the second case, just prior to the pericardectomy, an episode of mental confusion occurred and prompted the cessation of bromocriptine therapy. DISCUSSION: To the best of our knowledge, only one case of constrictive pericarditis induced by bromocriptine therapy has previously been described in the literature. CONCLUSIONS: Our cases call attention to a possible association between bromocriptine use in patients who have Parkinson's disease and constrictive pericarditis.
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keywords = effusion
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4/58. The syndrome of pericarditis, arthritis, and camptodactyly: an under-recognized cause of pericardial constriction in children?

    The syndrome encompassing the combination of pericarditis, arthritis, and camptodactyly is a rarely described cause of pericardial constriction in children. It is likely that this association is being under-recognized. We report a new case in which the skeletal abnormalities were subtle. The syndrome should be included in the differential diagnosis of any child with persistent non-inflammatory pericardial effusion. A careful search at the bedside for the associated skeletal abnormalities should lead to the correct diagnosis. pericardiectomy is the treatment of choice.
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keywords = effusion
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5/58. Purulent pericarditis presenting as an extracardiac mass in a patient with untreated diabetes.

    A 50-year-old man with symptoms of bi-ventricular heart failure was transferred to our hospital with a diagnosis of extracardiac tumor. He had a 10 year history of untreated diabetes. Chest computed tomography (CT) revealed an extracardiac mass in the right atrio-ventricular groove. cardiac catheterization revealed an elevated mean right atrial pressure of 18 mmHg, mean pulmonary wedge pressure of 16 mmHg, and the right ventricular pressure curve demonstrated typical dips and plateaus. At surgery, there was severe adhesion between the pericardium and epicardium, and the pericardium was severely thickened and contained turbid pus. In the left thoracic cavity, there was large amount of pleural effusion and pus. Therefore, the patient was diagnosed with purulent pericarditis caused by left empyema. The thickened pericardium at the anterior portion of the heart was resected, however resection of the remaining portion was abandoned because the adhesion was so tight. After surgery, the patient underwent irrigation of the heart and left thoracic cavity by 1% povidone iodine solution and 0.5 mg/ml of imipenem for 7 days. Bacteriologic culture of the pus from the pericardium revealed anaerobic gram negative bacteria. After 4 months of antibiotics infusion, his C reactive protein became negative and the patient was subsequently discharged from our hospital.
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keywords = effusion
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6/58. Degos' disease with constrictive pericarditis: a case report.

    A 47-year-old man with Degos' disease was examined by echocardiography, which showed hypokinesis of the apical left ventricular wall with pericardial effusion. To evaluate the myocardial perfusion and coronary flow reserve, 201Tl scintigraphy and intracoronary Doppler flowmetry were performed. The coronary flow reserve was not decreased nor was there angiographical coronary stenosis, although a pressure study revealed constrictive dysfunction of both ventricles. The constrictive pericarditis might have been induced by pericardial vasculitis, thereby causing the left ventricular wall motion abnormality.
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keywords = effusion
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7/58. Constrictive pericarditis from an embolized hypodermic needle: radiographic, CT and MR imaging findings.

    We present the radiographic, computed tomographic (CT), and magnetic resonance (MR) findings in a woman with constrictive pericarditis due to an embolized hypodermic needle. The chest films revealed pleural effusions but no foreign body. The CT showed pericardial thickening and a linear foreign body of metallic attenuation in the right ventricular apex, and MR imaging revealed a signal void with magnetic susceptibility artifact. This case illustrates the capabilities and limitations of CT and MR imaging in hypodermic needle-induced constrictive pericarditis.
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keywords = effusion
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8/58. Myositis, polyserositis with a large pericardial effusion and constrictive pericarditis as manifestations of chronic graft-versus-host disease after non-myeloablative peripheral stem cell transplantation and subsequent donor lymphocyte infusion.

    The clinical features of chronic graft-versus-host disease (cGVHD) following a non-myeloablative peripheral blood stem cell (PBSC) transplant may differ from those that occur after a conventional allograft. We describe a man with Hodgkin's disease refractory to chemotherapy and radiotherapy who was transplanted from an HLA-identical brother, who developed cGVHD characterised, in particular, by polymyositis, polyserositis with a large pericardial effusion and constrictive pericarditis, 1 month after donor lymphocyte infusion for relapsed disease. Constrictive pericarditis has not been previously reported after a conventional allograft, and none of these features have been reported after a non-myeloablative transplant. The course of cGVHD necessitated potent immunosuppression leading to the presumed loss of graft-versus-lymphoma (GVL) effect.
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ranking = 5
keywords = effusion
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9/58. A case of effusive-constrictive pericarditis after cardiac surgery.

    A 60-year-old woman who had undergone repair of an atrial septal defect was readmitted to the hospital with dyspnea, abdominal distention, and leg edema 31 months after surgery. An echocardiogram demonstrated massive pericardial effusion. cardiac catheterization revealed elevation and equilibrium of the 4-chamber diastolic pressure and a dip-and-plateau pattern in the right and the left ventricular pressures. Despite removal of pericardial fluid by pericardiocentesis, the findings and symptoms did not improve. The patient underwent both parietal and visceral pericardiectomy after which striking hemodynamic and symptomatic improvement occurred. Effusive-constrictive pericarditis is uncommon but should be considered in patients with refractory heart failure and massive pericardial effusion showing no improvement after removal of pericardial fluid.
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ranking = 2
keywords = effusion
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10/58. Coexistence of tuberculous constrictive pericarditis and right atrial tuberculoma: a case report.

    Tuberculous constrictive pericarditis is a rare condition with a high mortality rate. The coexistence of constrictive pericarditis and intracardiac tuberculoma has not previously been reported. We report the case of a 65-year-old man presenting with left-side pleural effusion and signs of systemic venous congestion for 2 months. echocardiography and computerized tomography showed a thickened pericardium and a mass in the right atrium. pericardiectomy and excision of the right atrial mass were performed. Pathologic examination of the pericardium and the right atrial mass both revealed chronic granulomatous inflammation with acid-fast bacilli and confirmed the diagnosis of tuberculous constrictive pericarditis and right atrial tuberculoma. This case reminds us of the possibility of this type of rare combination of tuberculous constrictive pericarditis and intracardiac right atrial tuberculoma, and the need for complete imaging studies when such cases are encountered.
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